Creating more diseases

[TigerT20]

Now, I'll give you three guesses as to exactly why this is on my mind.

But to get to the point, diseases in 5e seem to be about as common as druids in full plate. The three in the DMG consist of one that might come up, one that could come up unless you handwave food and water, and another that doesn't even make sense. I know laughter is infectious but not that much...

So I came up with a few and wondered what other people could come up with:

Corpse Rot
People who spend lots of time around the dead and dying can catch this strange disease that breeds in death. Thought to feed off negative energy, it can be the true terror of many battlefields - especially when fighting creatures such as zombies.
A creature that comes into direct contact with a creature on 0 hit points, whether it is unconscious, dead, or dying, must make a DC 10 Constitution saving throw or become infected with the disease. Each time they repeat the saving throw increases the DC by 1 until they complete a long rest.
An infected creature must make a DC 15 Consitution saving throw each time it takes a long rest. On a failure, their hit point maximum drops by 1d4 + the number of days they have had the disease. If this takes them down to 0 hit points, they die instantly.
An infected creature can be given advantage on the save by another creature making a DC 15 Medicine check or expending one use of a healer's kit.

Flystrike
A creature that has a vicious wound that goes untreated can end up with flystrike.
If a creature suffers a critical hit, they must make a DC 10 Constitution saving throw. On a failure, the wound must be treated by expending one use of a healer's kit or the spell heal within 1d6 hours.
If the creature fails to find such healing, flies will come and lay eggs in the wound. In 1d4 days the eggs will hatch, and begin to burrow into the skin. At the start of each of the infected's turns, they take 1d6 piercing damage. If the creature ends its turn on 0 hit points, the maggots burrow into its heart and kill it instantly.
Applying fire to the wound before the eggs hatch deals 1 fire damage to the infected and kills the maggots.

And of course:
Coronavirus
A flu that is extremely difficult to cure, spreads like lightning and can kill off those who have been weakened.
An infected creature suffers a fever, a dry cough and a range of other symptoms. Each time the infected finishes a long rest, they must make a DC 10 Constitution saving throw or gain one level of exhaustion. On a successful save, the infected loses one level of exhaustion. If this would bring their exhaustion levels below 1, they are cured of the disease. A creature suffering from another disease has disadvantage on this saving throw.
A creature that is within 5 feet of an infected creature must make a DC 15 Constitution saving throw for each hour they spend within 5 feet of the infected. On a failure, they become infected.
This disease cannot be cured by any means other than a greater restoration spell.

[Lupine]

5e mostly doesn’t have diseases, because it doesn’t fit the hero theme very well.

That said, I agree with you that D&D should have more diseases, and that disease should be something scary and deadly, even to high level characters.

I’m away from my laptop right now, but I once homebrewed my own expansion module for introducing disease into D&D 5e. It hasn’t been playtested, nor has it really been polished, but I can go find it, if you would like to see it. (Assuming I can find a way that preserves my anonymity)

Also, your disease sound good (narratively), but you’re missing how they recover. While some are almost always fatal, many diseases can be recovered from, and some even go away on their own.

[Guy Lombard-O]

I don't know if there should be more disease in 5e or not, although I agree that the creeping horror of a disease or curse can definitely add something to certain games.

But 5e has made curses fairly easy to get rid of with Remove Curse, a mere 3rd level spell. Diseases are even easier to do away with, with Lesser Restoration available to any 3rd level cleric/bard/druid and a paladin's Lay on Hands making it possible for a 1st level character.

I think that's either the reason that we don't see more diseases, or part and parcel of a clear intent to minimize them in the game. So if you want to reintroduce them as a substantive part of the game, you'll have to really nerf those abilities in your game as far as disease is concerned. Which, if you do it with more than a single disease or maybe two, it'll likely make the players of characters with those abilities feel like you've basically removed their ability. You'd probably be smart to make a big change like that evident in your session zero if you want to make diseases a bigger part of your game.

[Lupine]

I don't know if there should be more disease in 5e or not, although I agree that the creeping horror of a disease or curse can definitely add something to certain games.

But 5e has made curses fairly easy to get rid of with Remove Curse, a mere 3rd level spell. Diseases are even easier to do away with, with Lesser Restoration available to any 3rd level cleric/bard/druid and a paladin's Lay on Hands making it possible for a 1st level character.

I get around the lesser restoration issue by making many diseases, some of which cannot be treated magically, some can only be treated magically, with the vast majority falling in between. kind of like bacteria, with magic being an anti-bacterial.

I agree the idea of nerfing those abilities is not good, but on those rare disease that cannot be magically treated, it really raises the fear, akin to the fear that we have when we hear about antibiotic resistant bacteria.

It's also been implied throughout 5e that the character levels make a character exceptional (ie, anyone can be a priest, but only a rare few may be clerics.) That feel should make pandemics real to the PCs, even in they themselves are not at significant risk of them. Likewise, the paladin's lay on hands suddenly becomes a lot more important in it's limitations when the PC is forced to choose between helping the needy, or saving his or her resources to support the party if they need it.

Likewise, it forces the choice for spellcasters, "do I choose to have x spell prepared, or do I effectively 'sacrifice' that spell for a disease killer."

[TigerT20]

5e mostly doesn’t have diseases, because it doesn’t fit the hero theme very well.

That said, I agree with you that D&D should have more diseases, and that disease should be something scary and deadly, even to high level characters.

I’m away from my laptop right now, but I once homebrewed my own expansion module for introducing disease into D&D 5e. It hasn’t been playtested, nor has it really been polished, but I can go find it, if you would like to see it. (Assuming I can find a way that preserves my anonymity)

Also, your disease sound good (narratively), but you’re missing how they recover. While some are almost always fatal, many diseases can be recovered from, and some even go away on their own.

My interpretation of the cures was the whole specific-beats-general idea with how if I mention certain abilities that can cure it, it infers others not mentioned cannot. So I opted for leaving it blank mostly so all abilties that cure diseases could work


I don't know if there should be more disease in 5e or not, although I agree that the creeping horror of a disease or curse can definitely add something to certain games.

But 5e has made curses fairly easy to get rid of with Remove Curse, a mere 3rd level spell. Diseases are even easier to do away with, with Lesser Restoration available to any 3rd level cleric/bard/druid and a paladin's Lay on Hands making it possible for a 1st level character.

I think that's either the reason that we don't see more diseases, or part and parcel of a clear intent to minimize them in the game. So if you want to reintroduce them as a substantive part of the game, you'll have to really nerf those abilities in your game as far as disease is concerned. Which, if you do it with more than a single disease or maybe two, it'll likely make the players of characters with those abilities feel like you've basically removed their ability. You'd probably be smart to make a big change like that evident in your session zero if you want to make diseases a bigger part of your game.

Ok, I'll be honest: I didn't actually know about Lay on Hands.
One thing that would be interesting to see is if every time a disease is cured magically, roll a d10 and add the number of times that disease has been cured magically by the players. If the result is equal to or higher than the level the player gained the ability (or got access to the spell slot expended) plus 10 - or 5 on a more adaptive disease - that particular case has a version that has evolved immunity. Essentially real-world superbugs.
Could lead to the party being less trigger-happy with disease curing and potentially lead to some tough decisions - every time you cure someone, the next cure will be harder and require more resources. Do you take the risk?